Mental Health and Pop Culture Series

Game of Thrones Part 5 of 5

It has been a while since I’ve made an entry in this series, and for that, I apologize. I received a few requests to write an entry about Ramsay Snow/Bolton, who some consider to be the biggest “pure” villain in the series to date. I asked one of my friends why he found Ramsay to be a bigger villain than Joffrey; after all, they both share certain characteristics, including sadism and symptoms of antisocial personality disorder. My friend responded that the difference, and what make Ramsay a bigger villain, is the manipulative and psychological torture, on top of the physical torture, that he inflicts on his victims - that Joffrey is really a one-dimensional character, but that Ramsay is multidimensional.

Ramsay is the illegitimate son of Roose Bolton and a miller’s wife who he raped. All of his life, Ramsay has been reminded of his lower status, and treated poorly by his father. At almost every opportunity, Roose puts Ramsay down. While Roose acknowledges that Ramsay is his illegitimate son, the emphasis is typically on the “illegitimate” part. Ramsay has learned a lot from his father, including how to be manipulative, however, while Roose is dangerous, he rightly believes that Ramsay is even more dangerous. While Roose eventually has Ramsay legitimized and made heir to House Bolton, Ramsay becomes suspicious after Roose re-marries (Walda Frey) and conceives a son. Ramsay kills his father, Walda, and their son, and therefore becomes the last living person to bear the name Bolton.

Ramsay’s behavior is likely a result of both the environment in which he grew up as well as biological nature; that is, both nature and nurture. Not much is known about Ramsay’s biological mother, but we learn a great deal about his father. The sigil of House Bolton is a flayed man, and while Westeros is reminiscent of the Middle Ages where flaying was a relatively common occurrence, it speak volumes about Roose’s psyche that he would choose his sigl to be a flayed man. Violence and torture meant nothing to Roose, and Ramsay therefore learned that it they should mean nothing to him. While the Boltons were allied with the Starks and the North, Roose betrayed them, and Ramsay learned from this as well. All of Ramsay’s life, he saw how his father treated other people, and his complete lack of remorse or feeling.

Ramsay freely admits to, and revels in the fact that he tortures and kills innocent people, and that he does so purely for his own enjoyment. Ramsay finds the torture and murder of innocents to make him feel powerful, which he feels that he needs to do in order to feed his otherwise low self-esteem, which has been beaten down repeatedly because of the way that his father always treated him. Ramsay displays a perverse childlike giddiness when he does anything from torturing and mutilating Theon Greyjoy into submission, to flaying people alive, to hunting women for sport.

In addition to antisocial personality disorder, Ramsay displays some symptoms of borderline personality disorder, in his ability to drastically change his mood and demeanor when talking about or talking to one person. He shows signs of tenderness and care on the one hand, while viciousness and brutality on the other. One of the most prominent examples of this behavior occurred after Theon helps Sansa Stark (who Ramsay married, raped repeatedly, tortured, and held captive) escape and they kill Ramsay’s lover Myranda along the way - Myranda was, perhaps, the only person who Ramsay really ‘felt’ anything for - when Ramsay discovers that Myranda was killed, he speaks to her corpse tenderly, explains how he intends to exact revenge, and laments over what could have been. However, in the next moment, when the maester asks Ramsay what should be done with her body, Ramsay flippantly says to feed her to the dogs.

Ramsay is a master manipulator, and uses psychological torture to his gain, which may at times be nothing more than to have fun. Ramsay displays a level of intelligence where he can easily trick his enemies, and he is adept at thinking on his feet. However, he does not concern himself with the consequences of his actions, and is not good with long-term planning. Additionally, Ramsay’s paranoia gets in the way of his clearest thinking.

As I alluded to earlier, based off of what his characterizations are, Ramsay is fairly easily diagnosed with antisocial personality disorder with additional symptoms of borderline personality disorder. He is clearly a sadist, a psychological manipulator, and also paranoid. It is my assessment that Ramsay suffers from the two comorbid personality disorders. As a result, treating someone like Ramsay may seem impossible. He is a master at playing mind games and he is openly proud of his deceit and torture. But, again, at the core, Ramsay is also, venting his frustrations due to his low self-esteem. I believe that effective treatment for Ramsay would include both medication, psychodynamic therapy, and systems theory. He has a lot of issues, and they seem to stem from his childhood traumas, growing up in his father’s house, but not being considered a part of the family. He suffers from a lack of positive attachment, but he’s really too old for typical attachment therapies. I believe that through the use of medications and psychodynamic and systems theories, he could make great progress.

My impression is that once he can address his childhood issues, he could build up his self-esteem, and better see where he fits into the system. But, because he poses a great danger to others, he needs to be medicated, and at least initial treatments would need to be done as an inpatient. I don’t believe he would be easy to treat, but I do believe that he would be treatable.